Fibromyalgia

Alternative Therapies

100

Having a variety of effects on the human body, name the plant that can be used as self-medication for treating fibromyalgia.

Cannabis

• Endocannabinoid neuromodulatory system is involved with multiple physiological systems such as inflammation, endocrine function, antinociception, nausea and vomiting.

• Consist of 2 cannabinoid receptors, CB1 and CB2. Binding of agonists on the pain transmission pathways can decrease nociception

200

Name 1 type of thermal therapy used to treat fibromyalgia.

Hot therapy, cold therapy/cryotherapy, spa therapy/balneotherapy, mud-baths, body warming

• Heat therapies such as spa therapy, mud-baths and body warming work on FM by decreasing muscle spasms, increasing peripheral vasodilation and raising the pain threshold of nerve endings.

• Cold therapies such as cryotherapy work to decrease the inflammatory reactions in the body and limit edema. Increase anti-inflammatory cytokines, beta-endorphins, immunostimulation. 

300

This form of therapy uses pure oxygen to reduce the symptoms of fibromyalgia.

Hyperbaric oxygen therapy

• MOA: Induce neuroplasticity and repair brain metabolism and glial function. Also affects mitochondrial function and stimulates nitric oxide production, promoting NO-dependent release of endogenous opioids.

400

True or False: Acupuncture has been shown to have high levels of efficacy in treating pain and stiffness for patients with fibromyalgia.

False. There are only low to moderate levels of efficacy. Acupuncture has been shown to be a safe treatment in improving sleep, general well-being and reducing pain and stiffness.

• Acupuncture is hypothesized to work by increasing serotonin levels. Patients with FM have lower amounts of serotonin corresponding to increasing pain. This may also be related to other abnormal findings such as sympathetic hyperactivity and altered HPA axis.

• Acupuncture has not been shown to be significantly more effective than sham acupuncture in certain studies.

500

Which of the following have been shown to have significant improvement in fibromyalgia patients with probiotics: self-reported pain, impulsive decision-making, quality of life, anxiety symptoms.

Impulsive decision-making.

• Probiotics has been suggested as a treatment option for fibromyalgia due to the microbiota-gut-brain axis, the system in which intestinal homeostasis may directly affect the brain.

• Correlation between degree of small intestinal bacterial overgrowth to FM pain intensity

• Placebo effect for the other 3 areas.

Physical Therapy

100

List some examples of physical aerobic exercise effective in reducing symptoms of fibromyalgia.

Sports, walking, running, cycling, dance, yoga, pilates, tai chi, water exercises

• Fibromyalgia patients are often intolerant of physical activity and tend to have a sedentary lifestyle that worsens symptoms.

• Regular exercise is important for countering age‐related loss of muscle, bone mass, and functional independence and can improve patients’ overall health while reducing risks associated with other chronic conditions.

• Physiological effects: improved feelings of energy, improved mood, reduced stress, anxiety, and depression, decreased pain sensation, improved sleep quality, associated with increased endorphins

• Conclusion: moderate improvements in health-related quality of life, modest evidence in reduced pain intensity and improved physical function

200

What are two types of exercise involved in increasing muscle strength and muscle length?

Resistance training and flexibility exercises

• Resistance training improves multidimensional function and quality of life, pain, tenderness, and muscle strength.

• Flexibility exercises are effective for reducing pain, fatigue, sleep disorders, improving quality of life and muscle flexibility.

• Suggested that aerobic exercises > resistance exercises > flexibility exercises

300

True or False: In comparison to land-based exercises, aquatic exercises generated significantly greater improvements in multidimensional function, self reported physical function, pain and stiffness.

False: No statistically significant or clinically relevant differences between the 2 forms of exercise.

• Hydrotherapy not only includes swimming but also exercises usually performed on land that are instead performed in water.

• Hydrodynamic properties of water including buoyancy, density, viscosity, and hydrostatic pressure provide resistance to movement that strength muscles and facilitate muscle relaxation. 

• Water enables a wider range of physical activities due to low joint impact, greater comfort, and prevention/treatment of muscle damage and soreness, resulting in common use in sports recovery and rehabilitation.

• Evidence of improved quality of life and pain reduction 

400

This passive physical therapy modality improves pain, fatigue, stiffness, anxiety, depression, and quality of life in fibromyalgia patients.

Massage therapy

• Types of massage therapies that were studied with positive effects included: myofascial release, connective tissue massage, manual lymphatic drainage, Shiatsu

• Proposed hypothesis: Massage aims release fascial restriction and treat myofascial fibrotic changes by breaking up excessive collagen adhesions, in turn reducing excess tension and promoting tissue healing. These effects contribute to pain improvement.

500

List 3 reasons why therapies that apply electrical analgesic currents (transcutaneous electrical nerve stimulation) lack evidence in verifying effectiveness in pain relief?

Few studies, no double-blinding, risk of bias, no mention of electrical stimulation intensities, combination strategies rather than isolated intervention, lack of mentioning interferential current

• IFC current is a medium-frequency current capable of achieving low-frequency electrical stimulation of the nerves without the unpleasant side effects associated with low-frequency stimulation, capable of pain relief, muscle stimulation, and improved local blood flow.

• Good summary of the variegated methodological and treatment approaches in PT studies that limit availability of literature on specific effectiveness of PT modalities in fibromyalgia.

Miscellaneous

100

True/False - the etiology of fibromyalgia is still unclear.

True

• CNS sensitization is thought to be the main mechanism involved

• Other factors, genetic, immunological, and hormonal, may play an important role

200

Mainstay Western treatment options at this point are centered around what?

Symptomatic relief

• The main goals of treatment are to alleviate pain, increase restorative sleep, and improve physical function

• NSAIDs and opioids have been shown to have a limited benefit

• Antidepressants and antiepileptics are the only FDA approved drug treatments 

300

What is the average age range in which patients are diagnosed with fibromyalgia?

35-45 years old

• However, most people have had some form of chronic pain that started much earlier in life

• Fibromyalgia affects as many as 4 million Americans 18 years and older

• Fibromyalgia affects women more commonly than men (6:4 F:M)

400

Name one trigger that can induce fibromyalgia?

infections (HCV, HIV, Coxsackie B, Parvovirus, Borrelia), physical trauma, vaccinations, chemical substances (i.e. smoking). Sometimes patients do not notice any precipitating factor.

500

Patients with fibromyalgia have 18 symmetrical (9 pairs) “tender points” which are specific areas near your join that are very sensitive to pain. Point to 2 pairs of tender points on your body.

(lower anterior neck, upper edge of breast, arm near the elbow, knee, base of skull in the back of the head, hip bone, upper outer buttocks, back of the neck, back of the shoulders)

• These points feel painful when only a small amount of pressure is applied - as little as a finger poke can make someone wince

• Tender points are about the size of a penny

• They are typically located near joints, but are not the joints themselves

• Previously, doctors used to base the diagnose fibromyalgia if patients had pain in 11 out of 18 tender points for at least 3 months - in 2010, updated guidelines no longer require counting of tender points

Nutrition

100

What diet is thought to reduce symptoms of fibromyalgia due to its anti-inflammatory properties?

Vegetarian Diet

• Vegetarian diets are rich in antioxidants, which are thought to relieve pain in patients with FM

• Several studies found improvements in pain, as well as stiffness and sleep quality

• Also associated with weight loss, which is thought to help relieve physical symptoms as well

• Study looking at the vegan diet in patients with FM found that the positive effects of the diet where lost when the patient returned to an omnivore diet

200

Which diet, when enriched with magnesium and tryptophan, has shown to be beneficial in reducing anxiety, mood disturbances, and other psychological symptoms in patients with fibromyalgia?

The Mediterranean diet

• 2020 randomized control trial conducted with middle aged women with fibromyalgia

• Compared the enriched mediterranean diet to standard mediterranean diet

• Found improvements in anxiety, mood disturbance, eating disorders, and body image in the experimental group

• No statistically significant effect was seen on sleep quality

300

This dietary additive excitotoxin has been associated with FM symptoms.

Monosodium Glutamate (MSG)

• Previous study took patients with FM and IBS and placed them on an MSG free diet

• Reduction in symptoms followed this 4 week diet in 37 of the patients studied

• A return of MSG to the diet was associated with a return of symptoms with increased severity and a decrease in the quality of life 

400

Deficiency of what mineral is associated with inflammation, muscle weakness, and pain in patients with fibromyalgia?

Magnesium

• Past studies have discovered lower levels of intracellular magnesium among patients with FM

• Deficiencies in magnesiums, in addition to the above symptoms, are linked to decreased pain thresholds and increased tenderness 

• At the correct dosage, magnesium supplementation has been linked to an improvement in these symptoms

500

Alleviation of GI symptoms in patients with FM has been associated with a low FODMAPs diet. The acronym FODMAPs stands for:

Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols

• Study conducted over a four week period looked at the elimination of foods with a high content of FODMAP (ex. dairy products, cereals, select fruits and vegetables)

• Studies using low FODMAP diets found reduction in pain and GI symptoms

• No significant effects on anxiety, depression, or quality of life